Nurse knows best

Charity-branded nurses, from Macmillan to Admiral, have become household names. These nurses normally work within the NHS with support from a charitable organisation.

Now, for the first time, a housing provider has employed its own nurse operating outside the NHS to provide its dementia and palliative care clients with a nursing and advocacy service.

Specialist needs

Housing 21, which provides retirement housing, care and support for older people, is more than half way through its two-year pilot of the country’s first ‘dementia voice’ nurse.

Morejoy Saineti, a dual-qualified adult and psychiatric nurse, acts as a pivot, co-ordinating clients’ services with carers, linking them with GPs and other community healthcare practitioners. She took up the role at the end of 2008 after the pilot was awarded £149,000 from the King’s Fund to employ a community-based end-of-life nurse to work within its dementia services team in Westminster, London.

Housing 21 employs around 1,700 carers in England, and was the first to recognise the need for extra help for community-based palliative care services for people with dementia.

David Williams, head of research and development at Housing 21, says: ‘The reason why we put this project forward was our front line carers in the community were working with people with dementia. But at end-of-life, these [clients] were either moved into residential care or admitted to hospital…the relationship between the carer and the individual with dementia ceased,’ he says.

Breaking this relationship, he says, was detrimental to clients’ health as it caused disorientation and confusion. The answer came in the form of Ms Saineti, whose qualifications and experience gave her the authority that Housing 21’s carers could not command from NHS professionals. As a full-time nurse, Ms Saineti feels her main role is to advocate for older clients.

‘Initially, when the carers tried to communicate with social workers or district nurses or GPs - they felt they were not being heard,’ she says. ‘I think I am an advocate in terms of negotiating care packages - I can negotiate, for instance, for more hours,’ she says.

Ms Saineti has been a nurse for 25 years and has a masters degree in health research. As part of her role, she trains Housing 21 carers and the families of clients how to look after an individual with dementia. So far, 41 residents have been referred to Ms Saineti from the primary care trust, GPs and carers, and her current caseload consists of 18 clients.

Working differently

Initially, making the transition from working for the NHS to a housing provider wasn’t easy. ‘It was a challenge in terms of breaking through initially and getting referrals from social services,’ recalls Ms Saineti. ‘Some district nurses did not understand who I was, or what I was doing’.

She had to explain her parameters to district nurses and some were cautious about sharing patient records - they did not know whether they would be handled with confidentiality. Now she’s settled in, Ms Saineti relishes the independence that working for a housing provider offers, particularly as there is no template to follow.

‘I’m not hindered by bureaucracy. I don’t get involved with politics - I’m just looking at the person.’ She says it can be more difficult to bring in change when working for the NHS.

Mr Williams adds that introducing a nurse into Housing 21’s services was ‘unusual’. ‘What we firmly believe in is moving away from a silo mentality of what organisations can provide, to meeting service users’ needs - and that incorporates health, social care and housing issues,’ he says.

He admits it was tricky at first. ‘For a third sector organisation, there were challenges in that it was the first nurse that we’ve employed,’ he says. ‘We had to second her [from the NHS] and match her terms and conditions such as superannuation/pensions, so that was quite complicated for us.’

Ms Saineti was eventually headhunted, explains Mr Williams. ‘Trying to get someone with the right skill mix - someone who’s dual-trained and has experience of palliative care, is very specific,’ he says.

As for building relationships with other health care professionals - that took time. ‘There were barriers when working with the primary care trusts and local authorities as a third sector agency -so it was a process of gaining their confidence,’ he concludes, adding that referrals are now ‘flooding in’.

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